- Community pharmacy
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A community pharmacy is a community-based pharmacy. The main responsibilities of a community pharmacy include appropriate procurement, storage, dispensing, and documentation of medicines. Therefore the community pharmacists should have the required education, skills, and competence to deliver these professional services.
In compliance with the vision of the community pharmacy section of the International Pharmaceutical Federation, community pharmacists should
1. be experts in pharmaceutical care, pharmacotherapy, and health promotion.
2. be professional communicators with patients, other healthcare providers, and decision makers.
3. deliver good quality in products, services, and communication.
4. document their actions and make descriptions and publications.
The concept
A community pharmacy can broadly be considered a community-based pharmacy. The main responsibilities of a community pharmacy include compounding, counseling, and dispensing of drugs on prescription to the patients with care, accuracy, and legality. Appropriate procurement, storage, dispensing and documentation of medicines are within the purview of its professional responsibilities. It is an important branch of the pharmacy profession and involves a qualified and pertinent pharmacist. Being closely in contact with general people, the community pharmacists should have the required education, skills and competence to deliver the professional service to the community.
Community health
Community health refers to the healthy status of the member of the community to solve the problems affecting their health and to the totality of a health care provided for the community. Community health broadly encompasses the entire gamut of community efforts for maintaining, protecting, improving the health of the people.
Modern community health seeks to bring together all the available health services (e.g. medical care, mother & child care, family planning services, environmental sanitation, laboratory services, disease control programme, health education).
Public health
Public health is the science and arts of— 1) Preventive disease 2) Prolonging lifespan 3) Promoting health and efficiency through organized community efforts for— i) the sanitation of the environment. ii) the control of communicable diseases iii) the education of the individual in personal hygiene iv) the organization of medical and nursing services for the early diagnosis and preventive treatment of disease. v)the development of the social machinery to ensure everyone a standard of living for maintenance of health.
A recent definition of public health, which meets the criteria of modern public health is as follows— “Public health is the planning carrying out an evolution of health measures and system services that both maintain and improve the health of a population group, prevent and control diseases within the population group”.
Difference between public health and community health
1.Public health is the science and art of preventing disease, prolonging life, and promoting health & efficiency through organised community efforts.
Community health refers to the healthy status of the member of the community to solve the problems affecting their health & to the totality of a health care provided for the community.
2.It is a part of community health.
It covers all the aspect of public health preventive disease & social medicine.
3.In practice, public health components are community water supply, proper sewage disposal, good housing etc.
Community health components are curative, preventive, promotive & rehabilitative services.
4.Its main objects are to control physical environmental and communi-cable disease.
Its main objects are to promote physical, mental, social well-being of the people.
5.Community participation is not needed.
Community participation is essential.
Definition of health
According to the WHO (1948), “Health is a state of complete physical, mental and social well being and not merely an absence of disease or infirmity so that each citizen can live a socially and economically productive life”.
Dimensions of health
There are four major dimensions of health included in the WHO definitions of health—
- Physical health
- Mental health
- Social health
- Spiritual health
Besides these, many more can be cited e.g.
- Emotional
- Vocational
- Philosophical
- Cultural
- Socio-economical
- Environmental
- Political
- Educational
- Nutritional
Community health needs assessments
Community health needs assessment (CHNA) is a dynamic process undertaken to identify the strengths and needs of the community, enable the community-wide establishment of health priorities and facilitate collaborative action planning directed at improving community health status and quality of life.
Its importance
1)Provides baseline information about the health status of community residents. 2) Ensures that decisions are based on solid information & evidence. 3) Helps set priorities. 4) Can be used to guide policy and program development. 5) Can provide information on which funding is allocated. 6) Can assist in mapping out links and is interdependent with other sectors. 7) Can provide information to identify opportunities for disease prevention, health promotion and health protection.
Health care
Health care is an expression of concern for fellow human beings. It is defined as the multitude of services rendered to individuals, families or communities by the agents of a health services or professions for the purpose of promoting, maintaining, monitoring or restoring health.
All services have one thing in common, people are being served i.e., diagnosed health cured, educated and rehabilitated by health personnel.
Medical care
The term medical care is not synonymous with health care. It refers chiefly to those personal services that are provided directly by physicians or rendered as the result physician’s instructions. It ranges from domiciliary care to residence hospital care. Medical care is a subset of health care system.
Health system
The health system is designed to deliver health services. In other words, it constitutes the management sector and involves organizational matters e.g., planning a)determining priorities b)mobilizing and allocating resources c)translating policy into services d)evaluation and health education.
Levels of health care
Health services are usually organized at three levels, each level supported by a higher level to which the patient is referred. Three levels are: A. Primary health care B. Secondary health care (intermediate level) C. Tertiary health care (central level)
A. Primary health care
a)Grass root level. b)first level on contact of individuals, the family and community with National Health System when essential health care (primary health care) is provided. c)This level of care is most effective within the context of the area’s needs and limitations because of providing by the primary health center or other sub center.
Example, Thana Health Complex & their Union sub centers.
B. Secondary Health Care (Intermediate Level)
At this level, more complex problems are dealt with. This care comprises essentially curative services and is provided by the district hospital and community health centre. This level is assigned to provide some specialist services particularly in internal medicine, general surgery, obstetrics, gynecology and pediatrics.
C. Tertiary health care (central level)
This level offers super specialist care. This care is provided by the regional or central level institutions. This institutions provide not only highly specialized care but also planning and managerial skills and teaching for specialized staff e,g. medical college hospital and other specialized hospital, cancer hospital, eye hospital, mental hospital etc.
Elements of PHC
Although specific services provided will vary in different countries and communities the Alma Ata (Kazakhstan) declaration has outlined eight essential components of PHC.
1.Education concerning prevailing health problems and the methods of preventing and controlling them. 2. Prevention and control of locally endemic diseases. 3. Extended immunization against major infectious diseases. 4. Maternal and child health care including family planning. 5. Provision of essentials drugs. 6. Promotion of food supply and proper nutrition. 7. Appropriate treatment of common diseases and injuries. 8. Sanitation and safe water supply.
Principle of PHC
The PHC approach is based on principles of society equity, national wide coverage, self reliance, intersectorial coordination and people’s involvement in the planning and implementation of the health programme.
- Equitable distribution
- Community participation
- Intersectorial co-ordination
- Appropriate Technology
1.Equitable Distribution: The first principle of in the PHC strategy is equity or equitable distribution of health services. i.e. health services must be shared equally by all people irrespective of their ability to pay and all (rich/poor, urban/rural) must have access to health services. At present, health services are mainly concentrated in the major towns and cities resulting an inequality of health to the rural people. PHC aims to redress the imbalance by shifting the centre of gravity of the health care system from cities to the rural areas and thus bring services as near people’s home as possible.
2. Community Participation: The involvement or participation of individuals, families and communities (social workers, health personnel, school teachers, religious, political and local leaders) in promotion of their own health and welfare is an essential ingredient of PHC. Thus the community should participate in the planning, implementation & maintenance of health services.
3. Inter-sectorial Co-ordination: The components of PHC can not be provided by the health sector alone. So PHC should involve in addition to the health sector, all related sectors & aspects of national and community development; in particularly agriculture, animal husbandry, food industry, education, housing, public works, communication and other sectors. To achieve such cooperation, countries may have to review their administrative system, reallocated their resources and introduce a suitable legislation to ensure co-ordination can take place.
4. Appropriate Technology: Appropriate technology has been defined as the technology that is scientifically sound, adaptable to local needs and acceptable to those, who apply it and those for whom it is used and that can be maintained by the people themselves, in keeping with the principle of self-reliance with the resources, the community and country can afford. This applies to using sophisticated technology and medicine in appropriate way against relevant health problem. e.g., domiciliary treatment of T.B, ORS therapy in cholera & diarrhoea.
Health Manpower
The most essential component of health services is health manpower. The concept of health manpower includes both professional and auxiliary health personnel, e.g. physicians, health visitors, auxiliary nurse, midwives, medico-social workers, health inspectors etc. All these personnel have a vital role to play in the delivery of preventive and curative services. They are all employees in the health care system.
Health Care System in Bangladesh
The health care are designated to meet the health needs of the community through the use of available knowledge and resources. The services provided should be comprehensive and community based. The resources must be distributed according to the needs of the community. The final outcome of good health care system is the changed health status or improve health status of the community which is expressed in terms of lives saved, death averted, disease prevented, disease treated, prolongation of life etc. Health care delivery system in Bangladesh based on PHC concept has got various Level of service delivery: A.Home and community level. Union level, B.Union sub centre (USC) or Health and family welfare centre; This is the first health facility level. C. Thana level, Thana Health Complex (THC): This is the first referral level. D. District Hospital: This is the secondary referral level. E. National Level: This is the tertiary referral level.
A)Primary level health care is delivered though USC or HFWC with one in each union domiciliary level, integrated health and family planning services through field workers for every 3000-4000 population and 31 bed capacities in hospitals.
B) The secondary level health care is provided through 100 bed capacities in district hospital. Facilities provide specialist services in internal medicine, general surgery, gynecology, pediatrics and obstetrics, eye clinical, pathology, blood transfusion and public health laboratories. C) Tertiary Level health care is available at the medical college hospital, public health and medical institutes and other specialist hospitals at the national level where a mass wide range of specialized as well as better laboratory facilities are available.
The referral system will be developed keeping in the view of the followings.
1. A clearly spent-out linkage between the specialized national institutes, medical college and district hospitals to ensure proper care and treatment of patients from the rural areas served by lower level facilities. 2. Patients from the rural areas referred by lower level facilities to district and medical college hospitals and specialized institutions should get preferential treatment after admission.
3. The system will be a two-way process under which patients from the rural areas will be sent into higher institutions while at the same time specialists from the district hospitals, may visit the thana health complexes for providing better quality services on the spot.
Health Problems in Bangladesh
The health problems of Bangladesh can be conveniently
grouped under the following headlines:
1. Population problems
2. Communicable disease problems
3. Nutritional problems
4.Environmental sanitation problems
5. Health problems.
Communicable Disease Problems
Communicable diseases are still the major diseases in Bangladesh. Mortality & morbidity due to these disease are very high. Infectious diseases like cholera, typhoid, tuberculosis, leprosy, tetanus, diphtheria, whooping cough, measles, rabies, venereal diseases and parasitic diseases like malaria, filariasis, worm infestations are responsible for major morbidity. An expanded immunization programme against six major disease (TB, Tetenus, Diphtheria, Whooping cough, Measles, Polio was undertaken for implementation).
Nutritional Problems
Bangladesh suffers from some of the most severe malnutrition problems. The present per capita intake is only 1850 kilo calorie which is by any standard, much below required need. Malnutrition results from the convergence of poverty, inequitable food distribution, disease, illiteracey, rapid population growth and environmental risks, compounded by cultural and social inequities. Severe undernutrition exists mainly among families of landless agricultural laborers and farmers with small holding.
Specific nutritional problems in the country are— a)Protein Energy Malnutrition (PEM): The chief cause of it is insufficient food intake. b) Nutritional Anemia: The most frequent cause is iron deficiency and less frequently follate and vitamin B12 deficiency. c) Xerophthalmia: The chief cause is nutritional deficiency of Vit-A. d) Iodine Deficiency Disorders: Goiter and other iodine deficiency disorders. e) Others: Lethyrism, endemic fluorosis etc.
Environmental Sanitation Problems
The most difficult problem to tackle in this country is perhaps the environmental sanitation problem which is multi-faceted and multi-factorial. The twin problems of environmental sanitation are— a)Lack of safe drinking water in many areas of the country. b)Preventive methods of excreta disposal.
Health Problems
1)Indiscriminate defecation resulting in filth and water pond disease like diarrahoea, dysentery, enteric fever, hepatitis, hook worm infestations. 2) Poor rural housing with no arrangement for proper ventilation, lighting etc. 3) Poor sanitation of public eating and market places. 4) Inadequate drainage, disposal of refuse and animal waste. 5) Absence of adequate MCH care services. 6) Absence and/ or adequate health education to the rural areas. 7) Absence and/or inadequate communications and transport facilities for workers of the public health. 8) Absence of control of communicable diseases.
Indigenous Systems of Medicine
Indigenous system of medicine always played an important role in meeting the global health care needs. According to WHO about 80% of the world population rely on traditional medicine for their primary healthcare needs. Six well recognised traditional medicine systems are Ayurveda & Yoga, Shidda, Unani, Naturopathy & Homeopathy.
Ayurveda, Shidda & Yoga are said to be the indigenous systems.
Manpower Requirement for Developing Infrastructure of Community Pharmacy
Category: Norms Suggested
- Doctors: 1person/3500 Population
- Pharmacists: 1person/1000 population
- Nurses: 1 person/5000 population
- Auxillar nurse: 1 person/5000 population (midwives)
- Sanitary Inspectors: 1 person/ 10,000 population
- Lab. Tech.: 1 person/ 10,000 population
Voluntary Health Agencies (Organisations)
1)World Health Organisation (WHO) 2)United Nations International Children Emergency Fund (UNICEF) 3) United Nations Development Programme (UNDP) 4) Food and Agriculture Organization (FAO) 5) International Labour Organization (ILO) 6) World Bank (WB) 7) United Nations Family Planning Association (UNFPA) 8) Asian Development Bank (ADB)
Health Related N. G.Os
1. International Centre for Diarrhoeal Disease & Research in Bangladesh (ICDDR,B) 2. Rockefeller Foundation 3. Ford Foundation 4. Co-operation for American Relief Everywhere (CARE) 5. International Red Cross (IRC) 6. Concern 7. Save the Children Fund 8. HEED (Health, Education & Economic Development) 9. OXFAM 10. Asia Foundation 11. Assistance for Blind Children
Me: 1) Name: Abu Hasan Md. Rezaur Rahman 2) Country: Bangladesh 3) University: Rajshahi University. 4) Department: Pharmacy
References
NCPA-Pfizer Digest, 2007
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